Navitus Health Solutions

1 001 – 5 000 Darbuotojai

Draudimas Konsultavimas Sveikatos priežiūra

„Navitus Health Solutions“ yra į sveikatos priežiūrą orientuota vaistų išmokų administravimo įmonė, teikianti paslaugas sveikatos planams, darbdaviams, vyriausybinėms programoms ir kitiems planų rėmėjams. Jos vaistų išmokų paslaugos apima vaistų sąrašo ir specialiųjų vaistų valdymą, žalos atlyginimo paraiškų administravimą, vaistinių tinklo priežiūrą, narių aptarnavimą ir skaitmeninės sveikatos integracijas. Įmonė taiko 100 proc. lėšų perdavimo, sąnaudų ir antkainio modelį ir bendradarbiauja su planų rėmėjais kaip fiduciarinis partneris, daugiausia dėmesio skiriantis vaistų prieinamumui, teisės aktų laikymuisi, klinikinei kokybei ir geresniems sveikatos rezultatams.

Darbai įmonėje

Payer Contracting Executive at Navitus Health Solutions (Remote, US)

Lead payer negotiations across commercial, Medicare Part D, and Medicaid plans. Expand specialty pharmacy access while protecting margins and maintaining contract compliance.

prieš 10 valandų

116 019 $ – 145 024 $ / metai

Nuotolinis Visas etatas Vidutinis lygis Vyresnysis specialistas Privaloma Kalba: anglų Vadovaujantis darbuotojas

Aprašymas

Manage payer negotiations from initial terms through renewals, including rates, network participation, and performance guarantees.
Create and carry out plans to expand payer access and secure additional contracts.
Identify payer networks that do not include Lumicera or its partner pharmacies.
Contact payers directly to learn credentialing and network requirements and pursue access opportunities.
Set, monitor, and negotiate payer pricing and service agreements.
Prepare credentialing materials and new contract applications for payer and government clients.
Gather supporting documents and reports for applications, contracts, and business reviews.
Coordinate agreements through the contracting process with internal and external stakeholders.
Meet with payer representatives to assess account management needs and support contract compliance.
Renew enrollment and credentials for existing payer and government plans, proactively checking for coverage gaps.
Coordinate contract and data projects for master service agreements, shared service agreements, and scopes of work.
Build relationships with established payers and resolve claims or payment discrepancies.
Review operational and documentation procedures for compliance with regulations and payer contracts.
Meet specialty pharmacy reporting obligations required to retain network contracts.
Analyze and prepare data, analytics, and presentations for payer clients and company leaders.
Report activities and opportunities to leadership regularly and in detail.
Comply with applicable state and federal regulations.
Carry out other assigned duties.

Reikalavimai

A bachelor's degree is required.
An MBA or another graduate degree is preferred.
Certified Pharmacy Technician credentials or a relevant industry certification are preferred.
At least five years of experience in payer contracting, managed care, or specialty pharmacy is required.
Experience negotiating payer or network agreements is required; specialty pharmacy or managed care contracting experience is preferred.
Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements is required.
Participate in, follow, and support compliance program objectives.
Interact consistently with colleagues in a cooperative and respectful manner.

Privalumai

Health, dental, and vision insurance described as top-of-industry benefits.
20 days of paid time off.
Four weeks of paid parental leave.
Nine paid holidays.
401(k) company match of up to 5%, with no vesting requirement.
Adoption assistance program.
Flexible spending account.
Educational assistance plan and professional membership support.
Referral bonus of up to $750.